A Dementia Way Forward

My last two posts were prompted by the campaign launched in the Daily Mail to get the Government to address the disgraceful state of care for people with dementia in this country.   It has very successfully exposed the level of outrage and injustice felt by relatives, but the focus has been on the high cost of care and the consequent  loss of the family home to pay for the care.   This, maybe incorrectly, can be interpreted as a desire by the relatives to hang to their inheritance.

My last post illustrates that the issues with dementia are much wider than that and require a radical and comprehensive approach to all the issues, not just a political quick fix.   There are no simple or quick solutions and the answers will require financial contributions from the Government and individual sufferers.

HERE IS MY TEN POINT TEN YEAR PLAN ——————-—-it will take that long to  transform the scale of the problems, but action should start right away :-

1. FOCUS NHS HEALTH SUPPORT ON BETTER DIAGNOSIS AND PREVENTION.

Better diagnostic consideration will eliminate confused older people who are wrongly assumed to have dementia, when they may have something that is easily treated, such as a urinary infection.    The other main role for the  NHS / GP service should be on prevention through targeted advice and support regarding risk factors e.g.:- obesity / exercise / diet / smoking.    In support terms improved free Audiology services have been shown to reduce isolation.

2. TRANSFER NHS FUNDS TO SOCIAL SERVICES ON CONDITION THEY EMPTY BLOCKED BEDS IN  THE NHS.

A great many NHS hospital beds are “blocked” by elderly patients with dementia awaiting a discharge, either into residential care or to their own with domicillary care support in the community.   The cost of keeping them in hospital is far higher than sending them home or to Residential Care, but the financial responsibility is an invisible wall which creates an impasse to sensible action.

The Government needs to grasp the nettle and transfer the money to Social Services.

3. GRANT FUND A TEN YEAR PROGRAMME OF RETIREMENT HOUSING. 

There needs to be much more retirement housing to give older people a range of options to downsize and release equity to pay for better support in later life.   The options need to include shared ownership as well as outright sale and also Social rented accommodation for those who can’t afford to purchase their home.   Also there needs to be the opportunity to release more equity to pay for care as it is needed, using the mechanism of staircasing down by selling back more equity.

In almost every case this will release back onto to the market a much needed family home.  Ten million new retirement homes in ten years would be a good start !

This type of housing is only suitable for people with dementia if the  support staff are specially trained e.g. the “locksmith”in the ExtraCare Charitable Trust’s retirement villages.

4. REINVIGORATE SPECIALIST RESIDENTIAL NURSING CARE.

Most Residential Care Homes have become warehouses for people with dementia.    Staff are largely untrained and poorly paid.    Many of the residents are over medicated to make them easier to look after.  There is little by way of stimulating activity.   It has become an “out of sight, out of mind” solution.

All this needs to change, starting with a nursing managed service.   Less use of drugs and individualised care.   Properly and equitably charged for between private and public payers, by having the same charges for everyone.    But, there also needs to be greater control on the use of “vulture capital”, which is creating excessive fees.

5. MASSIVELY EXPAND HOME CARE SERVICES.

Most people who need care would prefer to remain in their own homes.   With a little support for the sufferer and their carers this is eminently possible.     The support needs to be available early in the process and offer respite to carers who are often family members.

6. LAUNCH A NEW DEMENTIA NURSING QUALIFICATION.

Training in the sector should be boosted with a new work-experience based nursing qualification for careers specialising in dementia.   It should command higher salaries and be a mandatory requirement for 80% of all staff working in Residential Homes and Domicillary Care.

7. MOBILISE THE VOLUNTARY SECTOR WITH A DEMENTIA GRANTS FUND.

There will never be enough paid staff to support informal care in the community and therefore help will be required from the voluntary sector.   Several years ago the Alzheimer’s Society called for a million volunteers, so far they say they have 350,000.  They need seed funding to achieve the target, so they can  provide befriending visits / welfare advice / social clubs and more to anyone who might benefit from them.   Combating isolation should be a priority in the fight against dementia.

8. DE-RISK THE LONG-TERM CARE INSURANCE INDUSTRY TO STIMULATE NEW PRODUCTS.

The Dilnot Commission had a core ambition of stimulating new long-term care insurance products, but its recommendations were never taken up.    These should be revisited and de-risked to make them cheaper to the consumer and  more predictable to the insurance industry.    This would probably require a tax free mandatory scheme with a “stop loss” clause underwritten by the Government.

9. LAUNCH A BETTER REGULATED AND CHEAPER EQUITY RELEASE  OFFER.

Equity release is expensive and comes with onerous conditions.    However, it may be the only way to unlock equity in your house if you wish to remain in your home and require money to pay for care.  The Government could agree to provide a “cap” on costs in exchange for lower interests charges.

10. DOUBLE THE RESEARCH PROGRAMME ON THE CAUSES OF DEMENTIA.

The overall cost of dementia to the Country is enormous and still rising rapidly.     Though all the above measures will help, they will add even more to the costs, therefore it makes sense to invest in research to try and find better treatments and hopefully in due course a cure for all dementia related conditions.

 

I DO NOT  PRETEND THESE RECOMMENDATIONS ARE ALL MY OWN WORK, FAR FROM IT.    THEY ARE DRAWN FROM OVER THIRTY YEARS WORKING WITH SOME EXCELLENT STAFF AND A GREAT MANY ELDERLY RESIDENTS.   MY THANKS GO TO THEM ALL.

This entry was posted in Dementia, HEALTH, RETIREMENT HOUSING. Bookmark the permalink.

4 Responses to A Dementia Way Forward

  1. this post, is most thought provoking, and may be a few comments to add to the general problems of old age, and dementia. THANK YOU jOHN!

  2. I am just taking in Johns Blog and the 10 point plan over 10 years. It is an observation on life over a lifetimes experience working with the elderly, and their aspirations for a happy old age, and how society can can come to terms with their individual responsibility, as a single person and as a social society: We may all grow old one day? and then need support.
    From my personal perspective at 77 years of age, married, and previously a home owner, and now a leaseholder tenant in a retirement village,I offer the following thoughts:
    My mother and father lived a happily married life, and I am one of 4 siblings. Mum and dad had their own properties, until dad died {throat cancer] in 1997 at he age of 81, leaving mum at he age of 77.
    Mum became disorientated, and with support from the medical profession Mum was asked/requested to go to a support clinic for the elderly, undertook various cognitive test and was diagnosed with the onset of dementia. The upshot was that as my three sisters lived within the locality, and I some distance away. and we all had growing families: IT happened that mum during our holidays, individually as individual family groups, should be consulted and sent for respite to a local care home in the area { Anchor Homes}. Mum agreed and enjoyed the experience. Then as winter approached, and the dark nights Mum became more disorientated and lonely, We all talked with Mum as the greater family, and Mum was agreeable to the proposal to permanently move into the Care Home, in which she had had respite. This move was considered and done with the blessing of social services, and the local health care clinic. The only decision financially we had to take as a family was that we undertook to sell mum’s house and self finance Mum’s care for the for see-able future. Mum lived resided in that same care home until 2016 at the age of 94.
    Why I have rambled on like this; is that this episode gave my wife {molly] and I a period of very serious thinking to do between ourselves and our children, asking the question at my age then approaching retirement age:- ‘What do Molly and I wish with Life?’
    WE contemplated where we would live, would we move, and what would happen to the sole survivor at the time of death? did we wish to live near family [children] and or siblings. The upshot was a balance view, and about this time John Graham arrived on the scene with the proposal Of a locally built Extracare Village. It filled our dreams and reality it has lived up to the vision. WE now live in the retirement village some 350 souls all over 55+ now 60+, communal facilities, and an secure, safe place to live, with support in health and lifestyle issues.The resident 350+ all of a varying age profile from 60 to 98. Here one meets one neighbour and new friends, convivial conversations, and social activities are enjoyed
    The bottom line is that one steers one’s own ship, and what one puts into life, one gets out. We all have to think what we may wish out of life.
    DEmentia is, or could be a problem:however provided society does not think that all diagnosed dementia cases should be congregated within one location. It is an emotional question to ask: however in the retirement village such as ours, as in society the proportion of dementia residents are not beyond those in the local habitations of a city or town or village they can become engaged in the retirement village, and it helps the residents like me appreciate what may happen in later life, and help’s one to understand the ravages of old age, with a positive viewpoints.
    Again one cannot come to a retirement village later in life in my opinion, without appreciating what one may face at the point of state retirement age, and what one may expect from Life?

  3. Perceptions
    Dear John your Blog here on dementia, is very deep thinking, and extremely provoking. AS a resident with my wife of a retirement village, I have a perception of how in latter stages of old age, when support is sought, and given:- then misunderstandings may occur as to the actual support that may be given, and the reality as to what is agreed.
    The retirement village my wife and I reside in has ‘domiciliary care’, which is the type of heath care provided. This is not at the level of a ‘nursing home’ and its facilities. However we have the level of care provided equivalent to that in a ‘CARE HOME’, with the added bonus of great number of residents, and all residents living in an individual apartment, with a lockable front door.
    Misconceptions may arise when residents within the retirement village need or apply for
    Domiciliary care.
    Domiciliary care can be, housekeeping, health or a mixture of both. What may now transpire or be a misconception, is that the actual time and attention spent with each resident upon support, and that ‘evil’– “Monies paid “ for that service rendered. Domiciliary care has to be provided on a basis of trust, and to some extent, what I would call ‘’TERM’’ Assurance, on an economic basis? Emergency health care would be by a 999 or 101 call to the NHS services. Housekeeping is a matter of time available in an emergency, ( to render the apartment-Safe from further predictable hazardous events).
    Why I make these obvious comments is one of perception, both from family relatives and the resident involved point of view. The perception is once on or in a domiciliary service contract, then in any event of an ‘unforeseen event’ they- the resident/or family is/are entitled to demand the domiciliary care to act to a higher level of a care, and unlimited time spent, returning the apartment, back to a normal status.
    This or these misconceptions require to be explained by the retirement village management, and fully understood by the elderly resident and family. Maybe with age as we grow older, and into our latter years of old age we all need to be tolerant, but respectful to each other, and it takes a little longer for management, and for the younger person or their mind to appreciate, the skills of communication and a fundamental understanding of a commercial agreement of which a domiciliary agreement, is but just one, But a most important one , as it is a life style decision taken by all those involved.

  4. I am but a nobody, and maybe an ignorant one at that?? My dander is up fired, and my cup floweth over!!
    Today wednesday 7th. August 2019, the ‘daily Mail- Headline’?? Quote -/- Dementia is now the cause of one in 8 deaths-/- Unquote.
    I am dull, a little slow on the uptake? Is Dementia not an ailment to suffer? Is it in fact the cause of death???
    I need to refer to the English Oxford dictionary, and be a little educated in what is ‘DEMENTIA’?
    and is is a subject of death, or an illness of incapacity resulting in the organs of the body to fail? and so lead to death ultimately, but not a cause of Death???
    Answers on a postcard please, I am confused? I wish research into dementia to enable a more beneficial life to be lead, before the organs of the body fail, and death becomes one.? Question if dementia or its causes are a lack of brain functioning, can one be alive but ‘brain dead’?
    Come in all you believers in the swiss clinic hospital of euthanasia. Where are we going with our thoughts and wishes, Please?

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